• Yagazie Zina Udeaja, Kasim Ahmed, Ghalib Choudhury, and Lakshmanan Sekaran.
• Department of Stroke Medicine, Luton and Dunstable Hospital NHS Foundation Trust, Luton, UK yagazie.udeaja@nhs.net.
• BMJ Case Rep. 2021 Apr 20; 14 (4).

AbstractAn aortic arch floating thrombus is a rare cause of embolic ischaemic cerebral infarction. Previously, thrombolysis or mechanical thrombectomy has been used to treat acute cerebral infarction in this context; however, combination therapy using both modalities is yet to be published. The optimal management of aortic arch floating thrombi is debated. Endovascular removal, thrombolysis, vitamin K antagonists and recently, direct oral anticoagulants have been utilised to treat aortic arch floating thrombi. Herein, we highlight the case of a patient presenting with dense hemiparesis, dysphasia and chest pain. CT imaging revealed a left middle cerebral artery thrombus and concurrent aortic arch floating thrombus. He was successfully treated with acute thrombolysis and subsequent mechanical thrombectomy of the cerebral thrombus resulting in resolution of his neurological symptoms. Repeat imaging demonstrated persistence of the aortic arch floating thrombus despite thrombolysis. The aortic arch floating thrombus was managed successfully with direct oral anticoagulant therapy.© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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